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 ©Copyright
 Published: 29/11/2011

journal clubs

Registrars will be expected to present at one journal club during their attachment.  Once a month there is a combined Obstetric-Neonatal Journal Club, where one or two articles of interest to both disciplines are presented.

Don't underestimate how much time it might take to get through an article in sufficient detail to present at a journal club.  Critical appraisal of a journal article is a skill that you need to develop through practice, and evaluating the quality of the evidence available helps with making clinical decisions in your normal working practice.

Journal clubs are designed to help with disseminating new information and to learn how to critically appraise medical literature.

You will need to provide copies of the article at the session, but you cannot expect the participants to be able to read the article quickly and completely so you should summarise the information using overheads or a PowerPoint presentation.

Information which should be included in the journal club summary should include:

1

Title and authors and affiliated institutions

2

Background

  • Why was this study or audit undertaken?  What was the rationale behind it?
  • Are there similar studies which have looked at the same question?
  • Is there biological plausibility behind the study question?

3

Methods

  • This is the most important section of the presentation, so make sure you understand exactly what it was that the authors did, and why they chose that particular way to do it.
  • Think about what you might have done differently if you were trying to answer the same questions.

4

Statistics

  • Everybody skips over this because they don’t understand statistics. You will never learn if you don't spend some time thinking about what the statistics mean.
    • Seek some senior support from someone who has some understanding of what statistics are used.
  • Specifically for clinical trials, you should mention a sample size estimate as this determines whether they had the numbers to find a relevant difference.

5

Results

  • Whilst this is the bit that everyone is interested in, be careful here, particularly if you think the methods are not good.  If the methods are flawed, the results have to be viewed with caution.
  • It is best to sift out the important positive and negative findings, rather than mention them all.
  • Are all the participants accounted for? What was the follow-up like?
  • Did they look at any secondary outcomes which they did not have the power to find differences in?
  • Were the incidences of events in the study groups the same as that which they based their power calculations on?

6

Discussion

  • What are the limitations of the study?
  • Have the findings been interpreted correctly by the authors?
  • Is the study applicable to our or other populations?
  • Should it change our practice?

7

Don't take it personally

  • Finding an article, going through it in detail for a journal club, and presenting it takes a lot of time and effort.
  • Sometimes an article you thought was good on reading the abstract does not hold true to that promise once it has been looked at closely.
  • Often the collective opinion at the meeting is that the study has flaws (almost all studies do) but this does not mean that it was a bad article to present.  It is often easier to learn from studies which could have been better than to look at the (few and far between) high quality studies.

There are a number of resources available that can help you with learning how to read a journal article, but nothing substitutes continued practice.  A useful recent series of articles are those written by Trish Greenhalgh and published in the BMJ (Volume 315) in 1997.

For Auckland trainees and paediatricians, Professor Jane Harding runs an annual critical appraisal course which is highly recommended.

Carl Kuschel and Malcolm Battin, August 2004